scholarly journals Efficacy of entry exclusion strategy for DeBakey type III retrograde Stanford type A acute aortic dissection

2020 ◽  
Author(s):  
Yosuke Inoue ◽  
Hitoshi Matsuda ◽  
Jiro Matsuo ◽  
Takayuki Shijo ◽  
Atsushi Omura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type Iii ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract OBJECTIVES Resection of a primary entry tear is essential for the treatment of Stanford type A acute aortic dissection (AAAD). In DeBakey type III retrograde AAAD (DBIII-RAAAD), resection of the primary entry tear in the descending aorta is sometimes difficult. The frozen elephant trunk technique and thoracic endovascular aortic repair (TEVAR) enable the closure of the primary entry in the descending aorta. The aim of this study was to investigate the efficacy of resection or closure of primary entry, i.e. entry exclusion, in patients with DeBakey type III retrograde-AAAD. METHODS The medical records of 654 patients with AAAD who underwent emergency surgery between January 2000 and March 2019 were retrospectively reviewed, and 80 eligible patients with DeBakey type III retrograde-AAAD were divided into the excluded (n = 50; age, 62 ± 12 years) and residual (n = 30; age, 66 ± 14 years) groups according to postoperative computed tomography angiographic data of the false lumen around the primary entry. The excluded group was defined as having a postoperative false lumen at the level of the elephant trunk or thrombosis of the endograft including primary entry. Patients with early false lumen enhancement around the elephant trunk or an unresected primary entry tear after isolated hemiarch replacement were included in the residual group. The early and long-term surgical outcomes were compared between the groups. RESULTS The in-hospital mortality rate was 8% (6/80), with no significant difference observed between the excluded and the residual groups (10% and 7%, respectively; P > 0.99). Ninety-five percentage of the patients (20/21) achieved entry exclusion with stent grafts including the frozen elephant trunk procedure and TEVAR. Spinal cord ischaemia was not observed in either group. The cumulative overall survival at 5 years was comparable between the 2 groups (76% and 81% in the excluded and residual groups, respectively; P = 0.93). The 5-year freedom from distal aortic reoperation rate was significantly higher in the excluded group (97%) than in the residual group (97% vs 66%; P = 0.008). CONCLUSIONS Not only resection but also closure using the entry exclusion approach for DeBakey type III retrograde-AAAD utilizing new technologies including the frozen elephant trunk technique and TEVAR might mitigate dissection-related reoperations.

scholarly journals ­­ A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Author(s):  
Shi-bo Song ◽  
Po-yuan Hu ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background Acute Stanford type A aortic dissection is a lethal event with a high mortality rate and requires emergency intervention. The goal of salvage surgery is to keep the patient alive by addressing the problems of severe aortic regurgitation, tamponade, primary tear and malperfusion of organs,and, if possible, to prevent the late dissection-related complications in the proximal and downstream aorta. No standard treatment or techniques have been determined for this disease. We aim to describe a modified elephant trunk technique for acute type A aortic dissection and report the short-term outcomes of this surgical technique. Methods From February 2018 to August 2019, 16 patients who were diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique procedure at Xiamen Heart Centre (9men; age, 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%)had hypertension and poor blood control management. Operative mortality was 6.25%. The primary tears were located in the lesser curve of the aortic arch in 5 patients (31.3%), in the ascending aorta in 9 patients (56.3%), and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery in 14 patients (87.6%) and to the distal descending aorta in 2 patients (12.5%). The time of cardiopulmonary bypass(CPB),cross-clamping and cerebral perfusion were 215± 40.5,140.8±32.3, and 23±6 minutes, respectively. Aortic valve plasty was performed in 15 patients (93.8%). Additionally, the Bentall procedure and coronary artery repair were performed in 1 patient each (6.3%), respectively. The diameters at all levels were greater before discharge than those when on admission to the hospital, except for the diameter of the aortic arch. After 3 months, the diameters at the aortic arch, descending aorta of the diaphragm, bifurcation of the pulmonary artery had increased, but the diameter at the bifurcation level of the common iliac artery had changed little. Only the diameter of the distal stent aorta had increased significantly. Conclusion The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible, and it could be used for organ malperfusion as well. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shi-bo Song ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
Po-yuan Hu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. Methods From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. Conclusions The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection

2019 ◽  
Vol 29 (5) ◽  
pp. 753-760 ◽  
Author(s):  
Akira Furutachi ◽  
Masanori Takamatsu ◽  
Eijiro Nogami ◽  
Kohei Hamada ◽  
Junji Yunoki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Total Arch Replacement ◽  
Lumen Area ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Elephant Trunk Technique

Abstract OBJECTIVES The aim of this study was to evaluate the outcomes of the frozen elephant trunk (FET) technique, using the J Graft FROZENIX for Stanford type A acute aortic dissection, in comparison with the unfrozen elephant trunk technique. METHODS Between January 2010 and August 2018, we performed total arch replacement for Stanford type A acute aortic dissection in our hospital. Thirty patients were treated by the elephant trunk procedure (ET group), and 20 patients were treated by the FET procedure (FET group). To evaluate aortic remodelling, we measured the area of the aorta, the true lumen and the false lumen at 12 months of follow-up. RESULTS Preoperative characteristics and operation time were not significantly different between the 2 groups. The quantity of blood transfused was much greater in the ET group than in the FET group. Resection or closure of the most proximal entry tear was obtained in 73.3% (22 out of 30 patients) in the ET group and 100% (20 out of 20 patients) in the FET group (P = 0.015). There was no case that had recurrent nerve palsy or paraplegia in the FET group. Stent graft-induced new entry occurred in 3 cases (15.8%) in the FET group. There were no significant differences between the 2 groups in aortic area, true lumen area or false lumen area. CONCLUSIONS Total arch replacement with the FET technique in Stanford type A acute aortic dissection carries a risk of distinct complications; however, with thorough advance planning, it should be possible to safely institute this treatment. Further randomization, with a comparison of each technique, is required to provide clear conclusions whether the FET is useful for acute Stanford type A aortic dissection.

scholarly journals ­­ A modified frozen elephant trunk technique for acute Stanford type A aortic dissection

2020 ◽  
Author(s):  
Shi-bo Song ◽  
Po-yuan Hu ◽  
Xi-jie Wu ◽  
Yong Sun ◽  
Shi-hao Cai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Short Term ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract Background: Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes.Methods: From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 59.21±11.67 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results: Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB)，cross-clamping, and antegrade cerebral perfusion were 215.8± 40.5, 140.8±32.3, and 55.1±15.2 minutes, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling.Conclusions: The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

scholarly journals Outcome of Frozen Elephant Trunk Technique for Acute Type A Aortic Dissection

Medicine ◽  
2015 ◽  
Vol 94 (16) ◽  
pp. e694 ◽  
Author(s):  
Hui-Han Lin ◽  
Shou-Fu Liao ◽  
Ching-Feng Wu ◽  
Ping-Chun Li ◽  
Ming-Li Li
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique
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